That’s the big question as federal health officials investigate the case of a Dallas health worker who treated an Ebola patient and ended up with the disease herself.
These are professionals and this is the United States, where the best conditions and protective gear are available, unlike in West Africa.
The health worker wore protective gear while having extensive contact with Thomas Eric Duncan, the Liberian man who died Wednesday of Ebola at Texas Health Presbyterian Hospital.
Officials say she has not been able to pinpoint any breach in infection control protocols, although there apparently was a breach, they say.
The situation also raises fresh concerns about whether any U.S. hospital can safely handle Ebola patients, as health officials have insisted is possible. Some questions and answers about the new case.
Q: What protection do health workers have?
A: The exact gear can vary. A hazardous material-type suit usually includes a gown, two sets of gloves, a face mask, and an eye shield. There are strict protocols for how to use it correctly.
“When you put on your garb and you take off your garb, it’s a buddy system,” with another health worker watching to make sure it’s done right, said Dr. Dennis Maki, University of Wisconsin-Madison infectious disease specialist and former head of hospital infection control.
Q: How might infection have occurred?
A: Officials are focusing on two areas: How the garb was removed, and the intensive medical procedures Duncan underwent, which included kidney dialysis and being hooked up to a respirator. Both involve inserting tubes into the body. That raises the risk a health worker will have contact with the patient's bodily fluids, which is how Ebola spreads.
Q: How else could infection have happened?
A: Some of the garb the health worker takes off might brush against a surface and contaminate it. New data suggest that even tiny droplets of a patient's body fluids can contain the virus, Maki said.
“I can have on the suit and be very careful, but I can pick up some secretions or body fluids on a surface” and spread it that way, he said.
Q: Can any U.S. hospital safely treat Ebola patients?
A: Health officials say yes, but others say the new case shows the risks.
“We can’t control where the Ebola patient appears,” so every hospital’s emergency room needs to be prepared to isolate patients and take infection control precautions, Maki said.
That said, “I don’t think we should expect that small hospitals take care of Ebola patients,” Maki said. “The challenge is formidable.”
The case heightens concern for health workers’ safety, and nurses at many hospitals “are alarmed at the inadequate preparation they see,” says a statement from Rose Ann DeMoro, executive director of the National Nurses United union.
Q: Should Ebola patients be transferred to one of the specialized centers that have treated others in the U.S.?
A: Specialized units are the ideal, but there are fewer than half a dozen in the nation and they don't have unlimited beds. "It is also a high-risk activity to transfer patients," potentially exposing more people to the virus, said said Dr. Eileen Farnon, a Temple University doctor who formerly worked at the U.S. Centers for Disease Control and Protection and led teams investigating past Ebola outbreaks in Africa.
Q. What is CDC recommending the hospital do?
A. Training has been ramped up, and the CDC now recommends the hospital minimize the number of people caring for an Ebola patient, perform only procedures essential to support the patient's care, and name a fulltime infection control supervisor while any Ebola patient is being cared for.
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